Professional training in motivational interviewing, as on many other topics, is often delivered via a one-time clinical workshop. To what extent do practitioners actually acquire skillfulness through such training? Twenty-two counselors participated in training, of whom 15 completed a study of changes in practice behavior up to 4 months after a motivational interviewing workshop. In addition to self-report questionnaires, they provided taped practice samples before and after training, which were coded for counselor and client behavior. On paper-and-pencil measures, participants reported large increases in motivational interviewing skills. Observational measures reflected more modest changes in practice behavior that were often retained 4 months after training. Clients, however, did not show the response changes that have been found to be predictive of better outcomes with motivational interviewing. While practice behavior changed to a statistically significant extent, the effect of training was apparently not large enough to make a difference in client response. Possible implications for training and quality control of psychotherapies are considered.
A randomized clinical trial assessed the effect of a group-based behavior modification intervention on oral hygiene skills, adherence and clinical outcomes for older periodontal patients. Subjects (n = 107) were aged 50-70 yr with moderate periodontal disease. They were randomly assigned to usual care or intervention. Intervention consisted of 5 weekly, 90-min sessions that included skill training, self-monitoring, weekly feedback about bleeding points and group support focused on long-term habit change. Four-month follow-up indicated significant improvements in the intervention versus the usual periodontal maintenance group for oral hygiene skills and self-reported flossing (p < 0.001), plaque, gingival bleeding, bleeding upon probing throughout the mouth, and pocket depth for sulcus depths that measured between 3 and 6 mm at baseline (p < 0.009). Group oral health intervention provides an effective and relatively inexpensive means of helping patients improve their self-care skills and achieve high levels of adherence to an effective self-care regimen.
We recommend implementation of hospital-based smoking-cessation counseling by professional counselors whose primary responsibility is to deliver the intervention. Recommendations for future research and for innovative ways to reach hospitalized smokers who are not receiving intervention are discussed.
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